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Entertainment Education for Depression in Latin Adults: Testing Mediators and Moderators of a Culture-Centric Narrative Intervention to Promote Help-Seeking Behavior

  • Author(s): Dixon De Silva, Louise
  • Advisor(s): Chavira, Denise A
  • et al.
Abstract

Although rates of depression are similar in Latinx populations compared to non-Latinx whites, there are significant disparities in service utilization. Mental health literacy – one’s knowledge and attitudes about mental health and treatment-seeking – is a significant predictor of help-seeking behavior and likely contributes to mental health disparities among Latinx. Understanding ways to improve mental health literacy in Latinx populations is important to reducing these disparities. Health literacy interventions that are engaging, dramatic, and culturally-relevant, such as fotonovelas (graphic novels designed to change health-related knowledge and attitudes), show promise in changing mental health literacy in Latinx populations. However, little is known about how these interventions work and for whom they are most effective. Furthermore, although there is some evidence that fotonovelas can change mental health attitudes and intent to seek treatment, their impact on help-seeking behavior is less understood. The purpose of this study is to examine 1) if a fotonovela is superior to a standard mental health literacy intervention in promoting help-seeking behavior among Latinx adults with depression symptoms, 2) if narrative and cultural elements of a fotonovela (i.e., transportation, identification, and social proliferation) for Latinx with depression are important mediators in changing mental health attitudes and help-seeking behaviors, and 3) if factors such as geographic region, depression severity and barriers to treatment moderate these relationships. This study utilized a randomized controlled design and recruited Latinx participants (N = 176) from both urban (n = 123) and rural (n = 53) communities all with mild, moderate, or severe symptoms of depression. Results showed that, compared to individuals who received a standard health literacy intervention (i.e., control group), individuals who received the fotonovela were more likely to seek mental health care 3 months later, reported greater transportation and identification with the narrative, and that transportation and identification mediated some of the relationships between intervention group and attitudes and beliefs about mental health. However, changes in attitudes and beliefs did not mediate the relationship between intervention group and help-seeking. Implications for entertainment education mental health literacy interventions are discussed.

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